Provider First Line Business Practice Location Address:
137 S PUGH ST
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-4734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-234-3381
Provider Business Practice Location Address Fax Number:
814-234-0994
Provider Enumeration Date:
10/24/2005